Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 20A4456 | CA |
NPI | 1982605655 |
---|---|
Provider Name | Robert Maurer |
First Address | Fullerton, CA 92835-1041 |
Second Address | Fullerton, CA 92835-3813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E10449 | (02) | CA |